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   2020| July-August  | Volume 33 | Issue 4  
    Online since May 16, 2021

 
 
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REVIEW ARTICLES
Convalescent plasma therapy for Covid-19: A systematic review
Tulika Seth, Arunmozhimaran Elavarasi, Ranjit Kumar Sahoo, Shalimar , Karan Madan, Neeraj Nischal, Manish Soneja, Pramod Garg, Kameshwar Prasad, Atul Sharma
July-August 2020, 33(4):213-221
DOI:10.4103/0970-258X.296202  
Background. Covid-19 has emerged as a pandemic affecting more than 20 million people till date with few, if any, proven therapy. Convalescent plasma (CP) containing antibodies against the virus has been used with some success. We did a systematic review to synthesize the available data on CP therapy for treatment of Covid-19 to study the efficacy and safety outcomes. Methods. Two reviewers searched the published and pre-published literature between 1 January 2019 and 23 June 2020 for studies comparing the use of CP with standard therapy for Covid-19 patients. Data from the selected studies were abstracted and analysed for efficacy and safety outcomes. Critical appraisal of the evidence was done by using the Joanna Briggs Institute tool and the quality of evidence was graded as per GRADE. Results. We found 13 case series and 1 randomized trial that fulfilled our search criteria. Of the 12 case series with a total of 264 patients that reported the efficacy outcomes, 11 studies showed favourable results with survival benefit. The only RCT with 103 patients did not show any mortality benefit but was terminated early prior to complete enrolment. A single large study of 5000 patients reported safety outcomes and showed no major adverse events in patient streated with CP. Conclusion. There is very low-quality evidence to suggest efficacy and safety of CP in patients with Covid-19 infection. Well-designed randomized trials are urgently needed to provide robust data.
  1,919 208 1
Efficacy and safety of antivirals for Covid-19: A systematic review and meta-analysis
Manya Prasad, Arunmozhimaran Elavarasi, Karan Madan, Neeraj Nischal, Manish Soneja, Tulika Seth, Ranjit Kumar Sahoo, Atul Sharma, Pramod Garg, Shalimar
July-August 2020, 33(4):222-231
DOI:10.4103/0970-258X.296203  
Background. Coronavirus disease 2019 (Covid-19) has led to a severe medical, social and economic crisis globally. Use of antivirals has given inconsistent results; thus systematic summaries of available evidence are required for any recommendations for treatment. We conducted a systematic review and meta-analysis on the use of antivirals for Covid-19. Methods. The databases we searched were—Medline, Embase, Cochrane CENTRAL and Medrxiv. Title/abstract screening, full-text screening and data abstraction were carried out in duplicate by two researchers. Pooled effect sizes and 95% confidence intervals (CI) were calculated using the Mantel-Haenszel method of random effects for meta-analysis. Results. Twenty studies were found eligible for inclusion: 6 randomized controlled trials, 9 cohort studies and 5 case series. Moderate-quality evidence suggests a likely clinical benefit from the use of remdesivir in improving the number of recoveries (RR 1.18; 95% CI 1.07–1.31; I2 = 0%) and time to recovery in days (median –3.02; 95% CI –4.98 to –1.07; I2 = 97%). A possibility of lower mortality is suggested by low-quality evidence with remdesivir (RR 0.74; 95% CI 0.40–1.37, I2 = 58%). Moderate-quality evidence suggests no certain benefit of using lopinavir/ritonavir for Covid-19 compared to arbidol, lopinavir/ritonavir combined with arbidol or other medications used as controls. Conclusion. Further evidence from randomized controlled trials is required for all antivirals to treat Covid-19. At present, remdesivir seems more promising than other antivirals.
  1,741 243 -
ORIGINAL ARTICLES
Study of pre-hospital care, patterns of injury and outcomes of suburban railway accident victims in Mumbai, India
Ruchita Bhoyar, Nitin Borle, Monty Khajanchi, Sanjay Nagral
July-August 2020, 33(4):201-204
DOI:10.4103/0970-258X.316263  
Background. India has one of the largest railway networks, with a high incidence of railway-related accidents and fatality rate of 150/million passengers per year. We evaluated the pre-hospitalization period, pattern of injury and outcome of train accident victims in a metropolitan city. Methods. For this prospective observational study, we included victims of railway accidents presenting to a public hospital of Mumbai (a metropolitan city) from November 2014 to September 2016. We documented a detailed history of the victims and patterns of injury. Injuries were assessed using the revised trauma score, injury severity score (ISS) and trauma score-ISS. The outcome of surviving persons was assessed using the European quality of life questionnaire (EQ-5D-5L) and visual analogue scale (EQ-VAS). Results. Eighty-one accident victims were admitted during the study period, of which 37 (46%) were seriously injured. The victims were predominantly male (85%), in the age group of 14–45 years (91%), 23 (28%) were in an intoxicated state. Most accidents happened during morning and evening peak hours (60%). The average time for victims to reach hospital was 38.1 minutes and 77 (95%) were transported by an ambulance accompanied by a doctor, while 8 (10%) received first aid at the railway station or in the ambulance. Ten (12%) accident victims died while 71 (88%) were discharged. Conclusions. We found a high incidence of people in their productive age group losing their lives to railway accidents, which can be prevented with the help of a robust transport system and training the first responder emergency medical care providers.
  1,058 97 -
EDITORIAL
The Covid-19 Pandemic: Impact on primary and secondary healthcare in India
Shashi Kant
July-August 2020, 33(4):193-194
DOI:10.4103/0970-258X.316251  
  805 117 -
ORIGINAL ARTICLES
Burden of falls among elderly persons in India: A systematic review and meta-analysis
Ravneet Kaur, Mani Kalaivani, Akhil Dhanesh Goel, Anil Kumar Goswami, Baridalyne Nongkynrih, Sanjeev Kumar Gupta
July-August 2020, 33(4):195-200
DOI:10.4103/0970-258X.316253  
Background. Falls are one of the leading causes of death and disability among elderly persons. In India, there is paucity of data on the prevalence of falls, particularly among community-dwelling elderly persons. To estimate healthcare costs related to falls and formulation of fall prevention strategies, there is a need of reliable estimates of magnitude of falls. We aimed to provide a community-based pooled estimate of the burden of falls among elderly persons in India. Methods. A systematic literature search was done manually as well as electronically through PubMed, Google Scholar, Cochrane library, IndMed, Embase and WHO databases. Community-based original studies conducted in India were included. No restriction for the date was used. Meta-analysis was done using the random effects model. Results. Sixteen studies were included in the review and meta-analysis. These studies included a total of 14 844 elderly persons, of which 2707 reported falling. The pooled prevalence of falls was found to be 31% (95% CI 23%–39%). There was significant heterogeneity between the studies (I2 = 98.08%, p<0.01). Conclusion. There is a high prevalence of falls among elderly persons in India. However, the available studies have considerable methodological variations and are of limited quality. Realistic estimates are required for designing programmes for prevention of falls and for rehabilitation.
  544 116 -
CLINICAL CASE REPORTS
A 38-year-old HIV elite controller from Bengaluru, Karnataka, India
Sanjana Chetana Shanmukhappa, Rahul R Abraham, Ashoojit Kaur Anand, Praneeth Pillala
July-August 2020, 33(4):210-212
DOI:10.4103/0970-258X.316250  
Elite controllers (ECs) constitute a rare subset of HIV-infected individuals who possess the remarkable ability to suppress viral replication (defined as an undetectable viral load or viral load <50 copies/ml for >12 months) in the absence of antiretroviral therapy (ART). Studies show that immunological parameters and indicators of long-term complications demonstrate the benefits of initiation of ART even in patients with undetectable viral loads or normal CD4 levels. We describe one such HIV EC from Bengaluru, Karnataka, India. This HIV-positive patient has been asymptomatic for several years in the absence of treatment. Multiple tests on viral load were undetectable. The patient was initiated on ART in view of falling CD4 counts, to ameliorate the high CD8 levels and to prevent future cardiovascular events.
  502 57 -
HISTORY OF MEDICINE
The Medical Repository: The first medical journal of the USA
Sanjay A Pai
July-August 2020, 33(4):239-244
DOI:10.4103/0970-258X.316248  
  399 53 -
CORRESPONDENCE
Malaria case detection in Chhattisgarh, 2015–2019: Comparison of cases reported by the National Vector Borne Disease Control Programme and community health workers
Samir Garg, Prabir K Chatterjee, Mukesh Dewangan, Prabodh Nanda
July-August 2020, 33(4):252-253
DOI:10.4103/0970-258X.316259  
  363 60 -
CLINICAL CASE REPORTS
Mitral valve repair in an octogenarian with symptomatic severe mitral regurgitation: First use of MitraClip in India
Sai Satish, Krishnaswamy Chandrasekaran, Moody Makar, Robert Mao, Abraham Oomen, Vijay Shankar, C Sadasivan, Ganapathy A Chandrasekar, Hemalatha Senthil, Mathew Samuel Kalarickal, Saibal Kar
July-August 2020, 33(4):207-209
DOI:10.4103/0970-258X.316256  
Percutaneous mitral valve repair is an accepted treatment of choice in Europe and North America for severe primary or secondary mitral regurgitation, in highly symptomatic patients for whom surgical repair is prohibitively high risk. We describe the first use of the MitraClip in India in a frail elderly female with symptomatic heart failure from severe primary mitral regurgitation who was considered high risk for surgical repair. She had substantial improvement in her symptoms as well as quality of life following the procedure.
  347 75 -
IMAGES IN MEDICINE
A rare side-effect of fluoroquinolones
Sanjeev Kapoor, Kamal Gera, Gurmeet Singh Chabbra
July-August 2020, 33(4):251-251
DOI:10.4103/0970-258X.316265  
  349 71 1
CLINICAL CASE REPORTS
Nephrocalcinosis: An interesting case
Srinithya Vathi Subramanian, Arul , Jegan , Arun Prasad
July-August 2020, 33(4):205-206
DOI:10.4103/0970-258X.316254  
We report primary hyperoxaluria (PH) type 1 in a young female who presented with a history of right nephrectomy for recurrent renal calculi and pyelonephritis. Genetic study showed it to be a variant of AGXT gene mutation classical of PH type 1.
  343 66 -
MEDICAL EDUCATION
Perception of medical interns towards the skills they acquired
Meenakshi Lella, Sarala Narayana, Sowmya Chinnaiyan
July-August 2020, 33(4):236-238
DOI:10.4103/0970-258X.316249  
Background. The undergraduate medical course in India is for five-and-a-half years. Every medical student has to undergo compulsory rotating residential internship for 12 months. During this period, interns acquire skills under supervision. The literature shows they have limited experience and confidence in performing basic and emergency procedures. We assessed interns’ perception of their experience and competence. Methods. We did a questionnaire-based cross-sectional study among medical students after they had completed their internship to reflect on their experience and competence in various procedural skills. A questionnaire (25 questions) based on knowledge and skills was piloted by 15 interns and was reliable (Cronbach alpha 0.9). The Likert scale ranged from never observed to performed independently under supervision. Results. Seventy-eight of 80 interns responded; 51 were females (65.3%). Three-quarters of interns felt they could independently carry out venous blood sample collection, arterial blood gas interpretation, Pap smear specimen collection and digital rectal examination, but only half felt that they could do a lumbar puncture, cervical dilatation and collection of throat swab. Parenteral drug administration, catheterization, nasogastric tube insertion and cardiopulmonary resuscitation were done confidently by over 90%, but vaginal delivery and application of a plaster slab required assistance. The majority said that they had observed drainage of abscess, excision of sebaceous cyst and endotracheal tube intubation. Conclusion. Most interns felt that they were competent in performing simple surgical tasks independently. However, conducting a vaginal delivery and endotracheal tube intubation were tasks that needed more support.
  333 68 -
CORRESPONDENCE
Successful treatment of disseminated nocardiosis in a recipient of renal transplant
Soma Dutta, Ujjwayini Ray
July-August 2020, 33(4):253-254
DOI:10.4103/0970-258X.316264  
  337 61 1
SELECTED SUMMARIES
Antiplatelet therapy after intracerebral haemorrhage
Kameshwar Prasad
July-August 2020, 33(4):232-233
DOI:10.4103/0970-258X.316255  
  330 52 -
[email protected]
Poking and prying with a purpose
Ashish Mradul Bamania
July-August 2020, 33(4):249-249
DOI:10.4103/0970-258X.316252  
  322 46 -
LETTER FROM CHENNAI
Letter from Chennai
MK Mani
July-August 2020, 33(4):247-248
DOI:10.4103/0970-258X.316257  
  289 35 -
OBITUARY
Jitendra Nath Pande
GC Khilnani
July-August 2020, 33(4):245-246
DOI:10.4103/0970-258X.316261  
  270 45 -
SELECTED SUMMARIES
Pneumothorax: Conservative or interventional treatment
Anant Mohan, Hariharan Iyer
July-August 2020, 33(4):233-235
DOI:10.4103/0970-258X.316258  
  261 52 -
IMAGES IN MEDICINE
Macrodystrophia lipomatosa: A rare form of localized gigantism
Mohd Ilyas, Zubair Ahmad, Naseer Choh
July-August 2020, 33(4):250-250
DOI:10.4103/0970-258X.316260  
  245 40 -
NEWS FROM HERE AND THERE
News from here and there

July-August 2020, 33(4):255-256
DOI:10.4103/0970-258X.316262  
  201 32 -